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Management of Systemic Lupus Erythematosus

i) Belimumab
Belimumab is a recombinant, fully human monoclonal antibody that
inhibits the biologic activity of B-lymphocyte stimulator (BLyS), also
known as B-cell activating factor (BAFF). This agent is indicated as an
adjunct therapy in patients with active SLE who are receiving standard
therapy and for the treatment of LN. 71, level III
In a Cochrane systematic review of six RCTs on SLE, belimumab was
more effective than placebo in terms of: 72, level I
• reduction of at least 4-point in SELENA-SLEDAI score (RR=1.33,
95% CI 1.22 to 1.45)
• improvement in quality of life based on 36-item short-form (SF-36)
(MD=1.60, 95% CI 0.30 to 2.90)
• reduction in corticosteroids dose by at least 50% (RR=1.59, 95%
CI 1.17 to 2.15)

In another systematic review of 12 studies which included seven RCTs,
belimumab was more effective than placebo in SLE patients based on
SLE Responder Index (SRI). 73, level I

Belimumab was reported to have a good safety profile. 72 - 73, level I

ii) Anifrolumab
Anifrolumab is a human monoclonal antibody to type I interferon
receptor subunit 1. It is a newly approved adjunct therapy for patients
with moderate to severe SLE.

In a landmark RCT among patients with moderate to severe SLE
(Treatment of Uncontrolled Lupus via the Interferon Pathway [TULIP]-2),
anifrolumab was more effective than placebo in terms of: 74, level I
• higher percentage of British Isles Lupus Assessment Group-
based Composite Lupus Assessment (BICLA) responder at week
52 (difference=16.3%, 95% CI 6.3 to 26.3)
• reduction of corticosteroids dose (difference=21.2%, 95% CI 6.8
to 35.7)
• reduction of CLASI by ≥50% at week 12 (difference=24.0%, 95%
CI 4.3 to 43.6)
The most frequent AEs among patients on anifrolumab reported in this
trial were upper respiratory tract infection, nasopharyngitis, infusion-
related reaction, bronchitis and herpes zoster.
iii) Rituximab
Rituximab is a chimeric anti-CD20 antibody that induces peripheral
B-cells depletion.

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